PRACTICAL SKILLS ON BLOOD SYSTEM PHYSIOLOGY
1. VSR (ESR) estimation methodics, the index norm.
2. Hemoglobin estimation methodics, the index norm.
3. Erythrocytes number estimation methodics, the index norm.
4. Leucocytes number estimation methodics, the index norm.
5. Coagulogram, main indexes norm.
6. Blood groups determining with Tsoliclons.
7. Blood groups determining with standard sera.
GLOSSARY
BLOOD SYSTEM PHYSIOLOGY
A
ABO system – the most common system of classification for red blood cell antigens; on the basis of antigens on erythrocytes surface, individuals can be type A, type B, type AB, or type O.
Acidosis – condition characterized by a lower than normal blood pH (pH of 7,35 or lower).
Adaptive immunity – immune system response in which there is an ability to recognize, remember and destroy a specific antigen.
Adhesion of platelets – the first stage of vascular-platelet hemostasis when platelets are attached to injured place in vascular wall.
Agglutination – a clumping of cells (usually erythrocytes) as a result of specific chemical interaction between surface antigens and antibodies.
Aggregation – making conglomerates.
Aggregation of platelets – the second stage of vascular-platelet hemostasis when thrombocytes are united together and form conglomerate.
Agranulocytes – leucocytes with very small cytoplasmic granules that cannot be easily seen with the light microscope; lymphocytes and monocytes.
Alkalosis - condition characterized by a higher than normal blood pH (pH of 7,45 or above).
Allergy – a state of hypersensitivity caused by exposure to allergens; it results in the liberation of histamine and other molecules with histamine-like effects.
Anemia – any condition that result sin less than normal hemoglobin in the blood or a lower than normal number of erythrocytes.
Anisocytosis – different-sized erythrocytes (microcytes, normocytes, macrocytes) simultaneous presence in one blood smear.
Antibodies – proteins found in the plasma that are responsible for antibody-mediated (humoral) immunity; immunoglobulin proteins (G, M, D, E, A, D) secreted by B-lymphocytes that have been transformed into plasmic cells (plasmocytes); their synthesis is induced by specific antigens and they combine with these specific antigens but not with unrelated antigens.
Antibody-mediated immunity – immunity resulting from B cells and the production of antibodies.
Anticoagulant – chemical that prevents coagulation or blood clotting; an example is antithrombin.
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Antigen – a molecule able to induce the production of antibodies and to react in a specific manner with antibodies.
Autoantibody – an antibody that is formed in response to, and that reacts with molecules that are part of one's own body.
Autoimmune disease – disorder resulting from a specific immune system reaction against self-antigens.
B
Basophil – the rarest type of leucocytes; a granular leucocyte with an affinity for blue (purple) stain with basic dyes; promotes inflammation, participates in allergy and prevents clot formation.
Basophylopeny – basophils number decreasing.
Basophyly – basophils number increasing.
Blood group – a category of erythrocytes based on the type of antigen on the surface of the red blood cells; for example, the ABO blood group is involved with transfusion reactions.
Buffer – chemical that prevents changes in pH when either an acid or base is added to a solution containing the buffer; it realizes this by either combining with hydrogen proton or by releasing hydrogen proton into solution.
C
Carbhemoglobin – hemoglobin compound with carbon dioxide.
Carboxyhemoglobin – hemoglobin compound with carbon monoxide the affinity to which is higher in 450 times than to oxygen that defines strong intoxication.
Cell-mediated immunity – immunity resulting from the actions of T-cells.
Clot – to coagulate; a soft insoluble mass formed when blood coagulates.
Clotting factor – one of many proteins found in the blood in an inactive state; activated in a series of chemical reactions that result in the formation of a blood clot.
Coagulation – the process of changing from a liquid to a solid, especially blood; main stages in blood are following: prothrombinase forming (by extrinsic or intrinsic way), prpthrombin transformation into thrombin (under prothrombinase action), fibrinogen transformation into fibrin (under thrombin action), clot retraction (under fibrinase action).
Complement – group of 9 serum proteins that stimulates phagocytosis, inflammation and lysis of cells.
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Constant region – part of an antibody that does not combine with an antigen and is the same in different antibodies, responsible for activation of complement and binding the antibody to cells such as macrophages, basophils, and mast cells.
Cyanosis – blue coloration of the skin and mucous membranes caused by insufficient oxygenation of blood.
D
Deoxyhemoglobin – the form of hemoglobin in which the heme groups are in normal reduced form but are not bound to a gas; deoxyhemoglobin is produced when oxyhemoglobin releases oxygen.
Donor – a face giving part of his blood, bone marrow, other tissues or organ for transfusion or transplanting to other person.
Duke probe – bleeding time from index finger or ear lobe at puncture making to the depth equal to 3 mm; index of vascular-platelet hemostasis; norm is 2-4 min.
E
Embryonic stem cells – the cells of the inner cell mass of a blastocyst; are pluripotent and so are potentially capable of differentiating into all tissue types except the trophoblast cells of a placenta.
Endothelium – the simple squamous epithelium that lines blood vessels and the heart.
Eosinophylopeny – eosinophils number lowering.
Eosinophils – granulocytic leucocytes with granules that stain red with acidic dyes; are capable to phagocytosis, participate in allergy.
Eosinophily – eosinophils number rising; in part, it is observed at allergy and helminthoses.
Erythroblast – immature erythrocyte, erythrocyte precursor.
Erythroblastosis fetalis – hemolytic anemia in a Rh-positive newborn caused by maternal antibodies against the Rh factor that has crossed the placenta.
Erythrocyte – a red blood cell; erythrocytes are formed elements of blood that represent biconcave discs, contain hemoglobin, transport oxygen and carbon dioxide; do not have a nucleus.
Erythrocytosis – erythrocytes number increasing.
Erythrocytopeny – erythrocytes number decreasing.
Erythropoiesis – erythrocytes formation; it is realized by 2 ways – specific – due to erythropoietin action; non-specific – due to hormones, vitamins and microelements action.
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Erythropoietin – the only specific regulator of erythropoiesis; protein hormone that stimulates erythrocyte formation.
Extrinsic way of prothrombinase formation – Hageman-dependent, trigger mechanism is hyperepinephrinemy; it is realized during blood coagulation.
F
Fibrin – threadlike protein fiber derived from fibrinogen by the action of thrombin; forms a clot, that is, a network of fibers that traps blood cells, platelets, and fluid, which stops bleeding.
Fibrinogen – a protein in plasma that gives rise to fibrin when acted on by thrombin to form a clot; serves a precursor of fibrin; also called as factor I; plasma without fibrinogen is known as serum.
Fibrinolysis – the breakdown of a clot by plasmin.
G
Gamma globulin – a family of proteins found in plasma; immunoglobulin G.
Granulocytes or granular leucocytes – leucocytes named according to the appearance, in stained preparations, of large cytoplasmic granules; neutrophils, basophils, eosinophils.
H
Hematocrit – the ratio of packed red blood cells to total blood volume in a centrifuged sample of blood, expressed as a percentage.
Hematopoiesis – production of blood cells.
Hemoglobin – the combination of heme pigment and protein within red blood cells that acts to transport oxygen and (to a lesser degree) carbon dioxide; hemoglobin also serves as a buffer.
Hemolysis – the rupture of erythrocytes.
Hemolytic disease of the newborn – destruction of erythrocytes in the fetus or newborn caused by antibodies produced in Rh-negative mother acting on the Rh-positive blood of the fetus or newborn.
Hemorrhage – rupture or leaking of blood from vessels.
Heparin – a mucopolysaccharide found in many tissues, but in greatest abundance in the lungs and liver. It prevents blood coagulation (so-called primary anticoagulant).
Homeostasis – existence and maintenance of a relatively constant environment within the body with respect to functions and composition of fluids and body tissues; the dynamic constancy of the internal environment, the maintenance of which is the principal functions of physiological regulatory mechanisms.
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Humoral immunity – the form of acquired immunity in which antibody molecules are secreted in response to antigenic stimulation (as opposed to cell-mediated immunity).
Hypervolemy - rising in circulating blood volume.
Hypovolemy – lowering in circulating blood volume.
I
Immunity – the ability to resist damage from foreign substances such as microorganisms and harmful chemicals such as toxins released by microorganisms.
Immunoglobulins – proteins that have antibody functions and provide humoral immunity; they belong to classes A, D, G, M, E.
Innate immunity – immune system response that is the same on each exposure to an antigen; there is no ability to remember a previous exposure to a specific antigen.
Interferons – small proteins that inhibit the multiplication of viruses inside host cells and that also have radioprotective, antitumorogenic and immunomodulative properties.
Interleukins – biologically-active substances that participate in interleucocytic integration (in part, during non-specific resistance and immune reactions).
Intrinsic way of prothrombinase formation – thromboplastin-dependent, trigger moment is celluls membrane damage and thromboplastin formation; it is realized during blood coagulation.
L
Lymphocyte – a type of mononuclear leucocyte; the cell responsible for humoral and cell-mediated immunity.
Lymphocytopeny – lymphocytes number lowering.
Lymphocytosis – lymphocytes number rising.
Lymphokine – any of a group of chemicals released from T cells that contribute to cell-mediated immunity.
M
Macrophage – any large mononuclear phagocytic cell that contributes to both specific and non-specific immunity.
Megacaryocyte – a bone marrow cell that gives rise to blood platelets.
Methemoglobin – the abnormal form of hemoglobin in which the iron atoms in heme are oxidized to the ferrous form (Fe has covalence not II but III) due to which metHb is incapable of bonding with oxygen.
Microcirculative, primary or vascular-platelet hemostasis – is realized in shine vessels or (together with blood coagulation) in large ones; there are 4 stages in it: vascular spasm, platelets adhesion, platelets aggregation, plug retraction.
Microphage – basophil, eosinophil and neutrophil – little phagocytes present in blood.
Monoclonal antibodies – identical antibodies derived from a clone of genetically identical plasma cells.
Monocyte – a mononuclear, nongranular, phagocytic leucocyte that can be transformed into macrophage.
Monocytopeny – monocytes number lowering.
Monocytosis – monocytes number rising.
O
Oncotic pressure – the colloid osmotic pressure of solutions produced by proteins; in plasma it serves to counterbalance the outward filtration of fluid from capillaries caused by hydrostatic pressure.
Osmolality – a measure of the total concentration of a solution; the number of moles of solute per kilogram of solvent.
Osmosis – the passage of solvent (water) from a more dilute to a more concentrated solution through a membrane that is more permeable to water than to the solute.
Osmotic pressure – a measure of the tendency for a solution to gain water by osmosis when separated by a membrane from pure water; directly related to the osmolality of the solution, it is the pressure required to just prevent osmosis.
Oxyhemoglobin – a compound formed by the bonding of molecular oxygen with hemoglobin.
P
pH scale – a measure of the hydrogen ion concentration of a solution; the scale extends from 0 to 14,0; a pH of 7,0 being neutral. A pH of less than 7,0 – acidic, and a pH of greater than 7,0 – basic.
Phagocytosis – process of ingestion and digestion by cells of substances such as other cells, bacteria, cell debris, and foreign particles.
Pinocytosis – cell drinking; invagination of the cell membrane to form narrow channels that pinch off into vacuoles; this permits cellular intake of extracellular fluid and dissolved molecules.
Plasma – the fluid portion of the blood; unlike serum (which lacks fibrinogen), plasma is capable of forming insoluble fibrin threads when in contact with test tubes.
Plasma cells – cells derived from B lymphocytes that produce and secrete large amounts of antibodies; they are responsible for humoral immunity.
Plasmin or fibrinolysin – an enzyme that breaks down the fibrin in blood clots; derived from plasminogen.
Plasminogen – fibrin precursor.
Platelet or thrombocyte – a disc-shaped structure, 2 to 4 micrometers in diameter, derived from bone marrow cells called megacaryocytes; platelets circulate in the blood and participate in vessels trophic function and hemostasis (both microcirculative and blood coagulation).
Platelet plug – accumulation of platelets that stick to connective tissue and to one another to prevent blood loss from damaged blood vessels.
Pluripotent - a term used to describe the ability of early embryonic cells to specialize to produce all tissues except the trophoblast cells in the placenta.
Polycytemia – increasing in erythrocytes, leucocytes and platelets number; sometimes in literature this term is used only for designation of only erythrocytes number increasing (thus, as a synonyme of the term erythrocytosis).
Prostaglandins – class of physiologically-active substances first derived from prosthate (it gave the name) present in many tissues; effects include vasodilation, pro- and antiaggregation, stimulation and contraction of uterine smooth muscle during menstruation and labor as well as promotion of inflammation and pain.
R
Reduced hemoglobin – hemoglobin with iron in the reduced ferrous state; it is able to bond with oxygen but is not combined with oxygen; also called deoxyhemoglobin.
Reticulocyte – erythrocyte precursor; name depends on net presence as endoplasmic reticulum.
Reticulocytosis – reticulocytes number increasing.
S
Serum – the fluid squeezed out of a clot as it retracts; supernatant when a sample of blood clots in a test tube and is centrifuged; serum is plasma from which fibrinogen and other clotting proteins have been removed as a result of clotting.
Sickle-cell anemia – a hereditary autosomal recessive trait that occurs primarily in people of African ancestry, in whom it evolved apparently as a protection (in the carrier state) against malaria; in the homozygous state, hemoglobin S is made instead of hemoglobin A, which leads to the characteristic sickling of red blood cells, hemolytic anemia and organs damage.
Stem cells – cells that are relatively undifferentiated (unspecialized) and able to divide and produce different specialized cells.
Suppressor T-cells – a subpopulation of T-lymphocytes that acts to inhibit the production of antibodies against specific antigens by B-lymphocytes.
T
T-cell – a type of lymphocyte that provides cell-mediated immunity (in contrast to B-lymphocytes that provide humoral immunity through the secretion of antibodies); there are three subpopulations of T-cells: cytotoxic (killer), helper and suppressor.
Thrombin – a protein formed in blood plasma during clotting that enzymatically converts the soluble protein fibrinogen into insoluble fibrin.
Thrombocyte – a blood platelet.
Thrombocytopeny – thrombocytes number lowering.
Thrombocytosis – thrombocytes number rising.
Thrombopoietin – a cytokine that stimulates the production of thrombocytes (blood platelets) from megakaryocytes in the bone marrow.
Thrombosis – the development or presence of a thrombus.
Thrombus – A blood clot produced by the formation of fibrin threads around a platelet plug.
W
White blood cells – see leucocytes.
TESTS ON BLOOD PHYSIOLOGY
1. Heparin sometimes is injected to experimental rats before blood taking if they possess blood coagulation high degree. Why?
A. * Anticoagulation increasing.
B. Anticoagulation decreasing.
C. Coagulation increasing.
D. Fibrinolysis enforcement.
E. Fibrinolysis weakening.
2. Physiologists have established that RBC number in blood depends on bone marrow functional state as well as RBC life duration. Mark average term of erythrocyte life span:
A. * 120 days.
B. 70 days.
C. 50 days.
D. 150 days.
E. 220 days.
3. Blood was poured in a test-tube. Its coagulation time was assessed as 6 min. After thrombus formation the test-tube was putted to the thermostate. It was estimated in 1 day that thrombus got destroyed. It was directly due to:
A. *Plasmins.
B. Kinines.
C. Kallikreins.
D. Heparin.
E. Antithrombins.
4. Circulating blood volume in 80 kg-weighted person after durable physical overloading is 5,4 l, hematocrit – 50%, blood general protein – 80 g/l. These blood indexes first of all are the result of:
A. *Water loosing while sweating.
B. Erythrocytes number increasing.
C. Proteins content increasing in plasma.
D. Circulating blood volume rising up.
E. Diuresis enforcement.
5. Total blood results in 12-yeared patient N. are as following as: eosinophils amount is increased up to 12%. Mark the state this phenomenon can be observed:
A. *Ascaridosis.
B. General intoxication syndrome.
C. Pneumonia.
D. Immunodeficient state.
E. Acute respiratory viral infection.
6. Differentiated leucogram detection is one of important clinical investigated methods. This index reflects:
A.* Leucocytes different sets percentage correlation.
B. Total leucocytes.
C. Granulo- and agranulocytes percentage correlation.
D. Lymphocytes percentage to total leucocytes amount.
E. Granulocytes percentage correlation.
7. Human being was poisoned with carbonic monoxide (CO). Mark changings in blood at this:
A. *Carboxyhemoglobin formation.
B. Methemoglobin formation.
C. Carbhemoglobin formation.
D. Reducted hemoglobin formation.
E. Acidosis development.
8. Cyanides intoxication was detected while analysis of blood taking from corpse by forensic doctor. Mark death reason:
A. *Methemoglobin formation.
B. Carboxyhemoglobin formation.
C. Carbhemoglobin formation.
D. Reducted hemoglobin formation.
E. Blood pH changings.
9. It is known that erythrocytes main function represents oxygen transport from lungs to cells of all organism tissues. Mark erythrocytes compound providing this process:
A.*Hemoglobin.
B. Albumins.
C. Globulins.
D. Enzymes.
E. ATP.
10. Anemia is developed after stomach pyloric part removal. Mark this disease developmental reason in this case:
A. *Internal Kasl’s factor absence.
B. Vitamin D absorbtion disorder.
C. Vitamin C absorbtion disorder.
D. Iron absorbtion disorder in stomach.
E. Bone marrow dysfunction.
11. 150 mmol/l of NaCl (1 liter) was injected to the patient with blood loosing. Mark index that will be changed first of all:
A.* Blood oncotic pressure.
B. Intercellular liquid oncotic pressure.
C. Blood osmotic pressure.
D. Intercellular liquid osmotic pressure.
E. Intracellular osmotic pressure.
12. The sportsman total blood results are the following: Er – 5,5 x 1012/l, Hb – 180 g/l, L – 7 x 109/l, neutrophils – 84%, basophils – 0,5%, eosinophils – 0,5%, monocytes – 8%, lymphocytes – 27%. These indexes testify to stimulation first of all of:
A. *Erythropoiesis.
B. Leucopoiesis.
C. Lymphopoiesis.
D. Granulocytopoiesis.
E. Immunogenesis.
13. Blood group was detected in a woman during labor. RBC agglutination reaction occurred with standard sera of the 0(I), A(II) and did not occur with standard serum of the B(III). The investigated blood belongs to the group:
A. *B(III).
B. O(I).
C. A(II).
D. AB (IV).
E. None of them.
14. Blood typing was made in the pregnant. RBC agglutination occurred with standard sera of the 0(I), B(III) and did not occur with standard serum of the A(II). The investigated blood belongs to the group:
A. *A(II).
B. O(I).
C. B(III).
D. AB (IV).
E. None of them.
15. Blood typing has been made in 30-yeared man right before the operation. Blood is Rh(+). RBC agglutination did not occur with standard sera of the 0(I), A(II) and B(III). The investigated blood belongs to the group:
A. * O(I).
B. A(II).
C. B(III).
D. AB (IV).
E. None of them.
16. Vitamin K deficiency due to hepatic proteins synthesis after the disease in 16-yeared guy will lead first of all to disorder in:
A.*Blood coagulation.
B. Erythrocytes sedimentation velocity.
C. Anticoagulants formation.
D. Erythropoietins synthesis.
E. Blood oncotic pressure.
17. Erythropoiesis is under control both of nervous and humoral factors – erythropoietins. Which of inner organs participates mostly in this control?
A.*Kidneys.
B. Lungs.
C. Liver.
D. Alimentary tract.
E. Pancreas.
18. Doctor did not take into account at citrate blood hemotransfusion that such blood does not coagulate and bleeding is not interrupted. What was not taken into account by the doctor?
A. *Ca++-ions absence in such a blood.
B. K+-ions absence in such a blood.
C. Na+-ions absence in such a blood.
D. Mg++-ions absence in such a blood.
E. Any answer is correct.
19. Er content is a healthy person blood is 5,65 x 1012/l. The reason of this can be the fact that the investigated person:
A.*Lives in highland.
B. Is a miner.
C. Is the pregnant.
D. Is the adult.
E. Is a child of pre-school age.
20. Fibrinogen level in plasma in the pregnant was twice bigger than norm. Mark VSR probable values:
A. *40-50 mm/h.
B. 10-15 mm/h.
C. 2-12 mm/h.
D. 5-10 mm/h.
E. 0-5 mm/h.
21. Heart activity stoppage appeared in a patient as a result of citric blood great amount transfusion. Indicate to probable mechanism of received changings:
A.*Ca-ions lack in blood.
B. Iron excess.
C. Fibrinogen lack in blood.
D. Er excess.
E. Circulating immune complexes.
22. The patient complaints on durable bleeding at insignificant traumatic lesion. Blood laboratory analysis showed blood content disorder. Which of cells get in touch with this?
A. *Platelets.
B. Erythrocytes.
C. Neutrophils.
D. Lymphocytes.
E. Monocytes.
23. Doctor has performed workers’ examination for assessment their adaptation to physical loading after hard overloadings performance. What changings in total blood can be revealed?
A.*Redistributive leucocytosis.
B. Leucopeny.
C. Anemia.
D. Hypoalbuminemia.
E. Differentiated leucogram shift to the left.
24. The patient H. is having been sick for bronchial asthma for 15 years. What changings in differentiated leucogram can be found by the doctor in his leucogram?
A.*Eosinophyly.
B. Basophyly.
C. Leucocytosis.
D. Leucopeny.
E. Leucocytic formule shift to the left.
25. Blood in vascular bed is in liquid state under usual conditions. It is provided by:
A.*Vessels endothelium smooth surface.
B. Fibrin thin layer presence on vascular wall.
C. Prostacyclin synthesis with endotheliocytes.
D. Similar charge of vascular wall and blood formed elements.
E. All the mentioned factors.
26. 2 guys (18-yeared, 180 m in height) were examining. Body mass of one guy was 56 kg, the second one – 96 kg. Stress reaction was caused in them for autonomic nervous system disorders diagnostics. How blood coagulation will be changed in them?
A.*Will be without changings in the first one and will grow in the second one.
B. Will grow in the second one and will be without changings in the first one.
C. Will be decreased in the first one and will be without changings in the second one.
D. Will be without changings in the first one and will be reduced – in the second one.
E. Will be without changings in both.
27. Which of mentioned statements is true?
A.*Hb is in erythrocytes in healthy adult person blood.
B. WBC content is bigger than RBC in healthy adult person blood.
C. Platelets content is bigger than RBC in healthy adult person blood.
D. Lymphocytes level is more than the one of neutrophils in healthy adult person blood.
E. Eosinophils are the most widely-spread leucocytes set.
28. There is heparin in basophils granules. Which of anticoagulants activity is rised due to heparin action?
A.*Antithrombin III.
B. Antithrombin I.
C. Fibrin.
D. Prothrombin.
E. Fibrinogen.
29. Hepatocytes toxic injury with protein-synthesizing function in a patient is accompanied by albumins content as well as oncotic pressure significant decreasing in blood plasma. What phenomenon will be these changings results:
A. *Edemas appearance.
B. Diuresis decreasing.
C. ESR (VSR) decreasing.
D. Blood volume increasing.
E. Blood density increasing.
30. Gums disease is in a man. He has gums hyperemy due to microcirculative bed afferent vessels dilation. What leucocytes substance provided mentioned changings:
A. *Histamine.
B. Substance P.
C. Epinephrine.
D. Endorphins.
E. Acetylcholine.
31. Girl complaining on spontaneous (without traumas and other injuries) frequent subcutaneous hemorrhagies which do not disappear then for long. Blood analysis showed that platelets number decreasing up to 60x109/l. Platelet decreased number will be reflected to:
A. *Vessels endothelium trophycs.
B. Gases transport with blood.
C. Blood phagocytic peculiarities.
D. Blood osmotic pressure support.
E. Acid-alkaline equilibrium.
32. 27-yeared man addressed the doctor with complains on coagulation time increasing up to 15-18 minutes. What coagulation factor deficiency increases significantly platelets irreversible aggregation phase:
A. *Тhrombin.
B. Fibrinogen.
C. Аntihemophilic globuline В.
D. Аntihemophilic globuline С.
E. Кininogen.
33. Blood coagulation represents consequent enzymatic process. Indicate to vascular-platelet hemostasis phase Willebrand factor influences on:
A .*Platelet adhesion.
B. Vessels reflectory spasm.
C. Platelets reversible aggregation.
D. Platelets irreversible aggregation.
E. Platelet plug retraction.
34. Which of mentioned functions is not major for blood plasma:
A.. *О2 transporting.
B. Hormones transporting.
C. Red blood cells sizes support.
D. Chilomicrones transporting.
E. Antibodies transporting.
35. Hematocrit 41% means that in one blood unit:
A. *Erythrocytes, leucocytes and platelets represent 41 % from total volume.
B. 41 % of hemoglobin is present in plasma.
C. Blood plasma represents 41 % from total volume.
D. 41 % of hemoglobin is present in erythrocytes.
E. 41 % of blood elements are erythrocytes.
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